Background and Methods Little is known about antiretroviral therapy (ART) outcomes in prisoners in Africa. We conducted a retrospective review of outcomes of a large cohort of prisoners referred to a public sector, urban HIV clinic. The review included baseline characteristics, sequential CD4 cell counts and viral load results, complications and co-morbidities, mortality and loss to follow-up up to 96 weeks on ART. Findings 148 inmates (133 male) initiated on ART were included in the study. By week 96 on ART, 73% of all inmates enrolled in the study and 92% of those still accessing care had an undetectable viral load (<400copies/ml). The median CD4 cell count increased from 122 cells/mm3 at baseline to 356 cells/mm3 by 96 weeks. By study end, 96 (65%) inmates had ever received tuberculosis (TB) therapy with 63 (43%) receiving therapy during the study: 28% had a history of TB prior to ART initiation, 33% were on TB therapy at ART initiation and 22% developed TB whilst on ART. Nine (6%) inmates died, 7 in the second year on ART. Loss to follow-up (LTF) was common: 14 (9%) patients were LTF whilst still incarcerated, 11 (7%) were LTF post-release and 9 (6%) whose movements could not be traced. 16 (11%) inmates had inter-correctional facility transfers and 34 (23%) were released of whom only 23 (68%) returned to the ART clinic for ongoing follow-up. Conclusions Inmates responded well to ART, despite a high frequency of TB/HIV co-infection. Attention should be directed towards ensuring eligible prisoners access ART programs promptly and that inter-facility transfers and release procedures facilitate continuity of care. Institutional TB control measures should remain a priority.
References
[1]
King's College London (2011) World Prison Brief, Africa. World Prison Brief. Available: http://www.kcl.ac.uk/depsta/law/research？/icps/worldbrief/?search=africa&x=Africa. Accessed 2011 Jul 7.
[2]
Dolan K, Kite B, Black E, Aceijas C, Stimson GV, et al. (2007) HIV in prison in low-income and middle-income countries. Lancet Infect Dis 7: 32–41.
[3]
World Health Organization, United Nations Office on Drugs and Crime, UNAIDS (2007) Interventions to address HIV in prisons: HIV care, treatment and support: evidence for action. Technical Papers. World Health Organization: Geneva.
[4]
UNODC (2007) HIV and prisons in sub-Saharan Africa: Opportunities for action. United Nations Office on Drugs and Crime, UNAIDS and World Bank. Available: http://www.unodc.org/documents/hiv-aids/？Africa%20HIV_Prison_Paper_Oct-23-07-en.p？df. Accessed 2011 Nov 5.
[5]
Department of Correctional Services (DCS) (2011) Statistical Information: 2011. Department of Correctional Services, South Africa. Available: http://www.dcs.gov.za/AboutUs/Statistica？lInformation.aspx. Accessed 2011 Nov 5.
[6]
UNAIDS, WHO (2009) AIDS epidemic update. UNAIDS and WHO, Geneva. Available: http://data.unaids.org/pub/Report/2009/J？C1700_Epi_Update_2009_en.pdf. Accessed 2011 Nov 3.
[7]
Republic of South Africa (2010) Country Progress Report on the Declaration of Commitment on HIV/AIDS: 2010 Report. South African Government. Available: http://data.unaids.org/pub/Report/2010/s？outhafrica_2010_country_progress_report_？en.pdf. Accessed 2010 Jul 14.
[8]
Scheibe A, Brown B, Duby Z, Bekker L-G (2011) Key populations, key responses: A gap analysis for key populations and HIV in South Africa, and recommendations for the National Strategic Plan for HIV/AIDS, STIs and TB (2012–2016). Desmond Tutu HIV Foundation and Joint UN Team on HIV and AIDS, South Africa. ISBN: 978-06-20-51676-1.
[9]
DCS (2011) Annual Report 2010/11: Department of Correctional Services Annual Report for the 2010/2011 Financial Year. DCS, Pretoria, South Africa Available: http://www.dcs.gov.za/Publications/Annua？l%20Reports/DCS%20Annual%20Report%202011？.pdf. Accessed 2012 Jan 4.
[10]
WHO (2011) WHO Report 2011: global Tuberculosis control. WHO, Geneva. ISBN 978 92 4 156438 0 Available: http://www.who.int/tb/publications/globa？l_report/2011/gtbr11_full.pdf. Accessed 2011 Oct 19.
[11]
Wood R, Liang H, Wu H, Middelkoop K, Oni T, et al. (2010) Changing prevalence of TB infection with increasing age in high TB burden townships in South Africa. Int J Tuberc Lung Dis 14(4): 406–412. Available: http://www.ncbi.nlm.nih.gov/pmc/articles？/PMC2837545/. Accessed 2011 Oct 19.
[12]
Habeenzu C, Mitarai S, Lubasi D, Mudenda V, Katenga T, et al. (2007) Tuberculosis and multidrug resistance in Zambian prisons, 2000–2001. Int J Tuberc Lung Dis 11: 1216–1220.
[13]
Moszynski P (2010) Zambian prisons “threaten public health” because of high rates of TB and HIV. BMJ 340: c2225. Available: doi:10.1136/bmj.c2225 via the Internet. Accessed 20 July 2010.
[14]
Wang EA, McCrann CH, Notha M, Mwasekaga MJ, Mwansa RA, et al. (2004) Rapid assessment of Tuberculosis in a large prison system – Botswana, 2002. Morb & Mort Wkly Report 52(12): 250–252. Available: http://www.medscape.com/viewarticle/4515？63_1. Accessed 2010 Jul 20.
[15]
Abrahao RMCM, Nogueira PA, Malucelli MIC (2006) Tuberculosis in county jail prisoners in the western sector of the city of Sao Paulo, Brazil. Int J Tuberc Lung Dis 10: 203–208.
[16]
Flanigan TP, Zaller N, Taylor L, Beckwith C, Kuester L, et al. (2009) HIV and infectious disease care in jails and prisons: breaking down the walls with the help of academic medicine. Trans Am Clin & Clim Assoc 120: 73–83.
[17]
Civil Society Prison Reform Initiation (2008) Deaths in custody and medical parole. CSPRI.
[18]
Palella FJ, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, et al. (1998) Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. N Eng J Med 338: 853–60.
[19]
Maruschak L (2008) HIV in Prisons, 2006. Report No: NCJ-222179. US Department of Justice, Bureau of Justice Statistics, Washington, DC. Available: http://bjs.ojp.usdoj.gov/index.cfm?ty=pb？detail&iid=952. Accessed 2010 Jul 21.
[20]
Centres for Disease Control and Prevention (1999) Decrease in AIDS-related mortality in a state correctional system: New York, 1995–1998. JAMA 281: 506–7.
[21]
Zachariah R, Bemelmans M, Akesson A, Gomani P, Phiri K, et al. (2011) Reduced tuberculosis case notification associated with scaling up antiretroviral treatment in rural Malawi. Int J Tuberc Lung Dis 15(7): 933–937. DOI:10.5588/ijtld.10.0666.
[22]
Lawn SD, Kranzer K, Wood R (2009) Antiretroviral Therapy for Control of the HIV-associated Tuberculosis Epidemic in Resource-Limited Settings. Clinics in Chest Medicine 30(4): 685–699. Available: http://www.sciencedirect.com/science/art？icle/pii/S0272523109000860. Accessed 2011 Oct 19.
[23]
Middelkoop K, Bekker L-G, Myer L, Johnson LF, Kloos M, et al. (2011) Antiretroviral Therapy and TB Notification Rates in a High Prevalence South African Community. J Acquir Immune Defic Syndr 56: 263–269.
[24]
Springer SA, Pesanti E, Hodges J, Macura T, Doros G, et al. (2004) Effectiveness of antiretroviral therapy among HIV-infected prisoners: re-incarceration and the lack of sustained benefit after release to the community. Clin Infect Dis 38: 1754–60.
[25]
Makombe SD, Jahn A, Tweya H, Thambo L, Kwong-Leung J, et al. (2007) A national survey of prisoners on antriretroviral therapy in Malawi: access to treatment and outcomes on therapy. J Infect Dev Ctries 1: 303–307.
[26]
Wilson D, Ford N, Ngammee V, Chua A, Kyaw Kyaw M (2007) HIV Prevention, care and treatment in two prisons in Thailand. PLoS Med 4(6): e204. Available: doi:10.1371/journal.pmed.0040204 via the Internet. Accessed 2010 Jul 8.
[27]
Berger J (2007) Implementing the Operational Plan in Prisons. AIDS Law Project 18 Month Review: January 2006 to June 2007 21–26. Available: http://www.tac.org.za/Documents/Court_Ca？ses/Westville_Prisoners/Alp2007.pdf. Accessed 2012 Jan 4.
[28]
DCS (2010) Department of Correctional Services Media Statement: Correctional Services Joins the Country in AIDS Day Commemorations. DCS, Pretoria, South Africa on 30 November 2010 Available: http://www.google.co.za/url?sa=t&rct=j&q？=antiretroviral%20site%3Awww.dcs.gov.za&？source=web&cd=1&ved=0CCAQFjAA&url=http%3？A%2F%2Fwww.dcs.gov.za%2FUploadedFiles%2F？AIDS%2520DAY.docx&ei=bVkVT6ThOc6YhQeL1YS？lAg&usg=AFQjCNETFc6CLCMu7bo2SzPhubpCwwGA？TQ&sig2=_V8CipySNmd8Pgd1r-KJGw&cad=rja.Accessed 2012 Jan 17.
[29]
Republic of South Africa (2006) Commission of inquiry into alleged incidents of corruption, maladministration, violence or intimidation in the Department of Correctional Services. Republic of South Africa. Available: http://www.info.gov.za/otherdocs/2006/ja？li/. Accessed 2011 Oct19.
[30]
Sanne IM, Westreich D, MacPhail AP, Rubel D, Majuba P, et al. (2009) Long term outcomes of antiretroviral therapy in a large HIV/AIDS care clinic in urban South Africa: a prospective cohort study. J Int AIDS Soc 12 38: 1–12.
[31]
Coetzee D, Hildebrand K, Boulle A, Maartens G, Louis F, et al. (2004) Outcomes after two years of providing anti-retroviral treatment in Khayelitsha, South Africa. AIDS 18: 887–895.
[32]
Ines SM, Moralejo L, Marcos M, Fuertes A, Luna G (2008) Adherence to highly active antiretroviral therapy in HIV-infected inmates. Curr HIV Res 6: 164–170.
[33]
Beckwith CG, Zaller ND, Fu JJ, Montague BT, Rich JD (2010) Opportunities to diagnose, treat, and prevent HIV in the criminal justice system. JAIDS 55(S1): S49–S55.
[34]
Babudiere S, Aceti A, D'Offizi GP, Carbonara S, Starnini G (2000) Directly observed therapy to treat HIV infection in prisoners. JAMA 284: 179–180.
[35]
Ford N, Nachega JB, Engel M, Mills E (2009) Directly observed antiretroviral therapy: a systematic review and meta-analysis of randomized clinical trials. Lancet 374: 2064–71.
[36]
Maru DS, Kozal MJ, Bruce RD, Springer S, Altice F (2007) Directly administered antiretroviral therapy for HIV-infected drug users does not have an impact on antiretroviral resistance: results from a randomized controlled trial. JAIDS 46: 555–563.
[37]
Pontali E (2005) Antiretroviral treatment in correctional facilities. HIV Clin Trials 6: 25–37.
[38]
Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, et al. (2011) Prevention of HIV-1 Infection with Early Antiretroviral Therapy. NEJM 365: 493–505. Available: http://www.nejm.org/doi/full/10.1056/NEJ？Moa1105243. Accessed 2012 Jan 4.
[39]
Cornell M, Grimsrud A, Fairall L, Fox MP, van Cutsem G, et al. (2010) Temporal changes in programme outcomes among adult patients initiating antiretroviral therapy across South Africa, 2002–2007. AIDS 24: 2263–2270.
[40]
Lawn SD, Kranzer K, Edwards DJ, McNally M, Bekker L-G, et al. (2010) Tuberculosis during the first year of antiretroviral therapy in a South African cohort using an intensive pretreatment screening strategy. AIDS 24: 1323–1328.
[41]
Egger M, May M, Chene G, Phillips AN, Ledergerber B, et al. (2002) Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies. Lancet 360: 119–129.
[42]
Lawn SD, Badri M, Wood R (2005) Tuberculosis among HIV-infected patients receiving ART: long term incidence and risk factors in a South African cohort. AIDS 19: 2109–2116.
[43]
National Department of Health (2010) Clinical Guidelines for the Management of HIV & AIDS in Adults and Adolescents NDOH, Pretoria, South Africa.
[44]
Nachega JB, Hislop M, Dowdy DW, Lo M, Omer SB, et al. (2006) Adherence to Highly Active Antiretroviral Therapy Assessed by Pharmacy Claims Predicts Survival in HIV infected South African Adults. JAIDS 43: 78–84.
[45]
Vermeulen JH (2011) Identifying structural barriers to antiretroviral therapy adherence Stellenbosch University, South Africa Available: http://scholar.sun.ac.za/bitstream/handl？e/10019.1/6539/vermeulen_identifying_201？1.pdf?sequence=1. Accessed 2011 Nov 8.
[46]
Stephenson BL, Wohl DA, Golin CE, Tien H-S, Stewart P, et al. (2005) Effect of release from prison and re-incarceration on the viral loads of HIV-infected individuals. Public Health Rep 120: 84–88.
[47]
Baillargeon J, Giordano T, Rich JD, Wu ZH, Wells K, et al. (2009) Accessing Antiretroviral Therapy Following Release From Prison. JAMA 301: 848–857.
[48]
Spaulding A, Stephenson B, Macalino G, Ruby W, Clarke JG, et al. (2002) Human immunodeficiency virus in correctional facilities: a review. Clin Infect Dis 35: 305–12.
[49]
Springer SA, Spaulding AC, Meyer JP, Altice FL (2011) Public Health Implications for Adequate Transitional Care for HIV-Infected Prisoners: Five Essential Components. Clin Infect Dis 53: 469–479.
[50]
Klein SJ, O'Connell DA, Devore BS, Wright LN, Birkhead GS (2002) Building an HIV continuum for inmates: New York State's criminal justice initiative. AIDS Educ Prev 14(5 Suppl B): 114–123.
[51]
Lawn SD, Myer L, Bekker L-G, Wood R (2007) Tuberculosis-associated immune reconstitution disease: incidence, risk factors and impact in an antiretroviral treatment service in South Africa. AIDS 21: 355–341.
[52]
Mphahlele M, Syre H, Valvatne H, Stavrum R, Mannasaker T, et al. (2008) Pyrazinamide resistance among South African multidrug-resistant Mycobacterium tuberculosis isolates. J Clin Microbiol 46: 3459–3464.
[53]
WHO (2008) Three I's Meeting: Intensified Case Finding (ICF), Isoniazid Preventive Therapy (IPT) and TB Infection Control (IC) for people living with HIV. World Health Organisation, HIV/AIDS Department, Geneva, Switzerland Available: http://www.who.int/hiv/pub/meetingreport？s/WHO_3Is_meeting_report.pdf. Accessed 2010 Jul 17.
